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Life Health > Health Insurance > Health Insurance

PPACA: The War of the Mini-Meds

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WASHINGTON BUREAU — Sen. Jay Rockefeller will hold a hearing Dec. 1 on whether limited-benefit “mini-med” plans should be classified as health plans.

Rockefeller, D-W.Va., chairman of the Senate Commerce Committee, scheduled the hearing after the U.S. Department of Health and Human Services (HHS) released interim final medical loss ratio (MLR) rules that will apply relatively loose minimum MLR standards to mini-med plans and to expatriate PPACA Caduceusmedical insurance policies.

“While I am disappointed that limited benefit ‘mini-med’ plans continue to seek exceptions from [MLR] standards, they should know that their requests will be subject to close scrutiny,” Rockefeller said. “As I have said before, I look forward to closely examining what type of coverage these plans provide to consumers over the coming year.”

John Greene, a vice president at the National Association of Health Underwriters (NAHU), Arlington, Va., defended the HHS decision and mini-med policies in general.

“What Sen. Rockefeller will find out is that mini-med plans serve a distinct employer population,” Greene said.

Mini-med policies tend to serve low-wage, short-term, transient workers, including new entrants to the work force, retail workers, and nursing home and home care aides, Greene says.

“Providing full-blown health insurance benefits is not

practical administratively, nor affordable if offered to them,” Greene says. “They tend to need services for more common ailments and these plans fill those needs at a cost they can afford.”

Ignoring the needs of the workers who have mini-med coverage “would be to force some employers to drop coverage altogether, which is contrary to the President’s promise,” Greene says.

Greene says members of Congress are starting to learn just how complicated health plan design and delivery is.

“Agents and brokers work closely with employers, and what we know is that employers provide the best coverage and benefits they can for their employees,” Greene says.

The minimum MLR regulations were drafted to guide implementation of provisions in the Affordable Care Act, the legislative package that includes the Patient Protection and Affordable Care Act (PPACA). The provisions, set to take effect Jan. 1, 2011, will require 85% of large group revenue and 80% of individual and small group revenue to be spent on patient care and quality improvement efforts.


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